{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:11:55Z","timestamp":1789668715463,"version":"4.0.1"},"reference-count":62,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Microscopic residual disease (R1)and node-positive disease in resected pancreatic ductal adenocarcinoma (PDAC) are associated with worse survival. Some have suggested that obtaining an R0 resection is no longer relevant when patients have node-positive disease. A meta-analysis confirming this hypothesis is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>A systematic review including studies with at least 50 patients with resected node-positive PDAC was conducted in PubMed, Embase, and Web of Science (inception to March 2025). Patients with node-negative disease were excluded. Primary outcome was overall survival (OS), comparing R0N+ and R1N+ resections. Hazard ratios (HR) with 95% confidence intervals (CI) represented outcome measures. Subgroup analysis included: application of the Royal College of Pathology protocol (RCP: standardized margin inking, axial slicing, and \u201c1-mm rule\u201d) and receipt of neoadjuvant\/adjuvant therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 19,206 patients with resected node-positive PDAC from 16 retrospective studies were included. Most patients underwent upfront resection (96.3%), primarily pancreatoduodenectomy (84.2%). The overall R0N+ rate was 61.1%, differing significantly by application of RCP (yes [R1 = tumor within 1 mm of margin]: nine studies, 52.1%; unclear: four studies, 80.5%; no [R1 = tumor at margin ink only]: three studies, 61.5%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0019). Overall, R1 negatively impacted OS (HR: 1.38; 95% CI: 1.21\u20131.59). RCP-only subgroup analysis confirmed worse OS in R1N+ resections (HR 1.25; 95% CI 1.10\u20131.42). Subgroup analysis by neoadjuvant\/adjuvant therapy was not feasible.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among patients with node-positive PDAC treated with upfront surgery, R1 resection remains associated with worse survival. In these patients, R0 resection should not be dismissed as a viable treatment goal until stronger RCP-compliant evidence emerges.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-19850-4","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T12:44:58Z","timestamp":1783514698000},"page":"9361-9371","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of R0\/R1 Margin Status on Overall Survival in Node-Positive Resected Pancreatic Ductal Adenocarcinoma: Meta-Analysis"],"prefix":"10.1245","volume":"33","author":[{"given":"A. M.","family":"Bonomi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Granieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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